CMS Rules and the Telehealth Revolution

To align with directives in the presidential executive orders signed on August 3, 2020, the Centers for Medicare and Medicaid Services (CMS) have proposed updates to their existing policies. These new proposals for the 2021 Medicare Physician Fee Schedule and Hospital Outpatient Rules will specifically have a significant impact on telehealth services.

According to Seema Verma, Administrator of the CMS, the agency quickly expanded the availability of telehealth during the pandemic in an effort to extend a lifeline to patients and providers amid stay-at-home orders. “In an earlier age, doctors commonly made house calls. Given how effectively and efficiently the healthcare system has adapted to the advent of telehealth, it’s become increasingly clear that it is poised to resurrect that tradition in modern form.”

Proposed Changes and Their Impact on Telehealth

Since the beginning of March 2020, CMS rapidly expanded payment for telehealth services and implemented flexibilities in response to the COVID-19 pandemic “so that Medicare beneficiaries living in all areas of the country can get convenient and high-quality care from the comfort of their home while avoiding unnecessary exposure to the virus.” The new rules allow organizations in the telehealth industry to further expand their service offerings and deliver improved benefits. The key changes to the Physician Fee Schedule and the Hospital Outpatient rules include:

1. Permanent implementation of new telehealth services. CMS has introduced nine codes to the list of services, including group therapy and neurobehavioral status exams. These codes will continue to be in effect after the new rules are implemented. However, genetic counseling is excluded; counselors cannot bill Medicare for their professional services, nor are they eligible as distant site practitioners for telehealth under the Social Security Act.
2. A new category for services instated during the Public Health Emergency (PHE) for the COVID-19 pandemic. Services that could be paid by telemedicine, such as emergency department visits, and psychological and neuropsychological testing, will remain on the list for the rest of the calendar year within which the PHE ends.
3. The extension of certain telemedicine services after the PHE ends. This provision allows beneficiaries more convenient ways to access healthcare services, especially in rural areas where healthcare options may be limited. Some of these services include home visits for the evaluation and management of a patient, and visits for patients with cognitive impairments. More importantly, this further establishes telehealth as a standard practice in healthcare. “Telemedicine can never fully replace in-person care, but it can complement and enhance in-person care by furnishing one more powerful clinical tool to increase access and choices for America’s seniors,” said Verma.
4. An increase in telehealth visits to nursing home residents. CMS is proposing to increase the frequency of nursing facility care services provided through telehealth from once every 30 days to once every three days.
5. Direct supervision via telehealth and incident-to-billing. Previously, a supervising physician was required to be physically present to assist in a clinical procedure. The new proposal will allow the virtual attendance of a physician to directly supervise pulmonary rehabilitation, cardiac rehabilitation, and intensive cardiac rehabilitation services using an interactive, audio-visual telemedicine platform.
6. Allowing audio-only technology. CMS authorizes the use of audio-only technology for payment for behavioral health services between Medicare beneficiaries and their physicians. This arrangement will be particularly significant for elderly patients with chronic conditions who have no access to audio-visual technology and high-speed internet.
7. Expanded types of clinicians. Physical and occupational therapists and speech-language pathologists can now connect with their patients via telehealth and be eligible for payment through Medicare.

What This Means for the Telehealth Industry

COVID-19 has accelerated the adoption of telehealth in everyday life. Over the past several months, patients had the opportunity to safely access medical care, while physicians have been given the ability to continue providing services and sustaining practices. Both parties experienced the future of healthcare. “[The] telehealth revolution is here to stay. The new gold standard for healthcare will be patients and providers deciding on the right blend of in-person and virtual care, when and where it makes sense for them,” said Alex Azar, United States Secretary of Health and Human Services.

The new CMS rules pave the way for continued expansion of telehealth, extending its benefits into rural and remote areas, community settings, and specialty care and mental health. However, there is still a need to place equal emphasis on maintaining regulatory requirements and compliance, while also putting the patient’s privacy and safety at the center of telehealth progress. However, the long term benefits are evident. Telehealth is set to improve patient outcomes and reduce the barriers to accessing quality healthcare.